Comparing Ondansetron with Ondansetron-Dexamethasone Combination on Postoperative Nausea and Vomiting after Elective Abdominal Surgeries: A Randomized Double Blinded Clinical Trial
AbstractBackground: Postoperative nausea and vomiting (PONV) is an unpleasant and distressing complication after abdominal surgeries. We conducted a study to compare the efficacy of Ondansetron-Dexamethasone combination with ondansetron alone on PONV after abdominal surgeries under general anesthesia.Methods: Two hundred patients undergoing elective abdominal surgeries under general anesthesia were allocated into two equal groups and anesthetised with the same technique. In one group combination of 8mg dexamethasone (2ml) and 4mg ondansetron (2ml) and in the other group ondansetron plus normal saline with the same volume was injected ten minutes before induction of anesthesia. PONV at recovery and during the first 24 hours after surgery were compared between the study groups.Results: Twenty-two patients in ondansetron group and nine patients in ondansetron plus dexamethasone group had PONV respectively at first hour in recovery room (P=0.01). Eight patients in ondansetron group and no patient in ondansetron plus dexamethasone group had PONV at first 24 hours after surgery in the ward (P=0.007). In ondansetron group 21 patients and in combination group 7 patients needed intravenous metoclopramide as rescue medication for treatment of PONV in recovery (P=0.02). Two patients in ondansetron group needed intravenous rescue medication for treatment of PONV in the ward (P=0.01).Conclusion: Dexamethasone plus ondansetron was more effective than ondansetron alone in preventing postoperative nausea and vomiting in patients undergoing elective abdominal surgeries.
Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89(3):652-8.
Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999; 91(3):693-700.
Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000; 84(1): 6-10.
D'souza N, Swami M, Bhagwat S. Comparative study of dexamethasone and ondansetron for prophylaxis of postoperative nausea and vomiting in laparoscopic gynecologic surgery. Int J Gynaecol Obstet. 2011; 113(2):124-7.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: Elaboration and explanation. BMJ. 2015; 350:g7647.
Chen CC, Siddiqui FJ, Chen TL, Chan ES, Tam KW. Dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing thyroidectomy: meta-analysis of randomized controlled trials. World J Surg. 2012; 36(1): 61-8.
Habib AS, Gan TJ. Combination therapy for postoperative nausea and vomiting–a more effective prophylaxis? Ambul Surg. 2001; 9(2):59-71.
Habib AS, El-Moalem HE, Gan TJ. The efficacy of the 5-HT3 receptor antagonists combined with droperidol for PONV prophylaxis is similar to their combination with dexamethasone. A metaanalysis of randomized controlled trials. Can J Anesth. 2004; 51(4):311–19.
Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012; 109(5):742-53.
Fernández-Guisasola J, Gómez-Arnau JI, Cabrera Y, del Valle SG. Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta-analysis. Anaesthesia. 2010; 65(4):379-87.
Wallenborn J, Gelbrich G, Bulst D, Behrends K, Wallenborn H, Rohrbach A, et al. Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomized double blind multicenter trial. BMJ. 2006; 333(7563):324.
Som A, Bhattacharjee S, Maitra S, Arora MK, Baidya DK. Combination of 5-HT3 Antagonist and Dexamethasone Is Superior to 5-HT3 Antagonist Alone for PONV Prophylaxis After Laparoscopic Surgeries: A Meta-analysis. Anesth Analg. 2016; 123(6):1418-26.
Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC. The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: a comparison of droperidol with saline. Anesth Analg 1999; 89(1):200-3.
Splinter WM, Rhine EJ. Low-dose ondansetron with dexamethasone more effectively decreases vomiting after strabismus surgery in children than high dose ondansetron. Anesthesiology 1998; 88(1):72-5.
Bano F, Zafar S, Aftab S, Haider S. Dexamethasone Plus Ondansetron for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy: A Comparison with Dexamethasone Alone. J Coll Physicians Surg Pak. 2008; 18(5):265-9.
Gautam B, Shrestha BR, Lama P, Rai S. Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ). 2008; 6(23):319-28.